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高效抗病毒治疗促使艾滋病患者免疫功能重建
The characteristics of AIDS is that HIV infection induces CD4 + T cell defects that includes a quantitave CD4 + T cells depletion and a loss of T helper cells function leading to a progressive immune deficiency. Early report indicated that this immune deficiency was irreversible, even with the antiretroviral therapies. More recently, however, clinical benifits of hightly active antiretroviral therapies (HAART) are increasingly evidenced by resolving opportunistic infections and malignancies, as well as declining hospitalization and mortality rates. This suggests that potent and sustained suppression of viral replication, at least to some extent, is associated with reconstitution of the immune system even in adult patients treated at advanced stages of the disease. Such immune reconstitution which was demonstrated firstly by a French reseach group includes (the group leader is Pr Brigitte Autran)(1) a rapid rise in CD4 + and CD8+ T cells followed by a slower CD4 + T cell increase; (2) a rapid rise in memory CD4 + T cells during the first three months of treatment by late increase in naive T cells coexpressing CD45RA and CD62L molecules after 3 months of efficient antiviral treatment;(3) a significant reduction of CD4 and CD8 activation markers in parallel to plasma virus load reduction;(4) a restoration in CD4 + T cell reactivity to recall antigens. These observations open new perspectives for the understanding of CD4 + T cells deficiency and therapeutic strategies of HIV infection. In the present review we will address some of the questions raised by immune restoration with HAART when administered at advanced stages of the disease.
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慢性病毒性肝炎抗病毒治疗进展慢性丙型肝炎抗病毒治疗的现状与对策
肝炎C病毒(HCV)感染在世界范围内总的流行率为3%~5%,一般人群感染率为1.8%,估计有1.7~2.0亿人感染HCV,是一全球的健康问题.慢性丙型肝炎(慢丙肝)的抗病毒治疗近10年从标准干扰素单治疗发展到标准干扰素(interferon,IFN)和利巴韦林(ribavirin,病毒唑RBV)联合治疗,新近又发展为聚乙二醇干扰素(pegylate interferon)和利巴韦林联合治疗,引起持续病毒应答(sustained virologic response,SVR)率提高,疗效增加,成为当今抗HCV治疗的模式.
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合并自身免疫现象的丙型肝炎与自身免疫性肝炎及干扰素抗病毒治疗诱导的自身免疫现象
我国是病毒性肝炎的高发国家,由病毒性肝炎而并发的肝硬化、肝癌严重危害我国人民健康.与乙型肝炎病毒感染相比,丙型肝炎病毒(HCV)感染后更易慢性化,约占成人HCV感染者的80%,因此对慢性丙型肝炎患者进行积极的抗病毒治疗显得尤为重要.到目前为止,干扰素联合利巴韦林被国内外公认为抗HCV的有效治疗方案,但干扰素在治疗丙型肝炎的过程中有时还可诱发甲状腺疾病、糖尿病、血小板减少症、溶血性贫血等多种肝外自身免疫损伤,重者不得不停用干扰素.
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慢性乙型肝炎经抗病毒治疗后复发及耐药的处理
目前,慢性乙型肝炎(CHB)抗病毒治疗领域得到越来越多的关注.抗病毒治疗是活动性CHB治疗的关键逐步得到了公认.在全球死于乙肝的病例中,高达21%系围生期感染所致;48%在婴幼儿期(<5岁)感染;而在5岁以上儿童期、青少年期和成年期感染仅不足1/3(31%).在我国,生命早期乙肝病毒(HBV)感染导致的CHB多为难治型,比欧美地区更为突出.同时,给CHB抗病毒治疗带来许多差别及更大的困难和挑战.对于CHB经α干扰素和拉米夫定治疗复发及耐药的处理也是棘手的问题之一.现就有关的认识初探如下.
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慢性乙型肝炎抗病毒新靶位和方法研究进展
慢性乙型肝炎是严重危害人体健康的疾病,它以持续性HBV复制所致的不同严重程度的肝脏炎性病变为特征,其中部分患者终可能发展为肝硬化、肝细胞肝癌或肝功能衰竭.慢性乙型肝炎治疗方法如保肝、降酶不能从根本上解决疾病的复发问题,其原因在于乙型肝炎病毒不能被清除或有效抑制.抗病毒治疗是控制慢性乙型肝炎的佳选择,但现有的抗病毒药物都存在疗效低及耐药的问题,因此必须寻求新的抗病毒靶位点及药物.